Positioning a medical device in the right atrium or right ventricle using a non-flexible catheter

Abstract

A device can be introduced into the right atrium of a subject's heart by introducing the distal end of a hollow, straight, and stiff shaft into the subject's right internal jugular vein, and advancing the distal end of the shaft into the right atrium via the superior vena cava. The position of the distal end of the shaft is adjusted by manipulating a handle affixed to a portion of the shaft that remains outside the subject's body. The handle can be used to rotate the shaft about its longitudinal axis, rotate the shaft about an anterior-posterior axis, rotate the shaft about a medial-lateral axis, and/or advance the shaft in the caudal direction. A device is advanced through the interior of the shaft until the device extends beyond the distal end of the shaft and into the right atrium.

What is claimed is: 
     
       1. A method of performing a procedure in a right atrium of a subject's heart, the method comprising:
 (a) introducing a distal end of a shaft into the subject's right internal jugular vein, wherein the shaft is hollow, straight, and stiff; 
 (b) advancing the distal end of the shaft into the subject's right atrium via the subject's right brachiocephalic vein and the subject's superior vena cava, wherein at least a portion of the shaft remains outside the subject's body after the distal end of the shaft is advanced into the subject's right atrium, and wherein the shaft passes directly posterior of the subject's clavicle bone and adjacent tissue so that the clavicle bone and the adjacent tissue serve as a fulcrum; 
 (c) advancing a device in a caudal direction through an interior of the shaft so that the device is positioned in the subject's right atrium and extends caudally beyond the distal end of the shaft; and 
 (d) adjusting a position of the distal end of the shaft by manipulating a handle affixed to the portion of the shaft that remains outside the subject's body, 
 wherein the manipulating of the handle results in at least one of rotating the shaft about an anterior-posterior axis with respect to the fulcrum and rotating the shaft about a medial-lateral axis with respect to the fulcrum. 
 
     
     
       2. The method of  claim 1 , wherein a bending member extends distally beyond the distal end of the shaft, wherein the bending member is configured to bend with only a single degree of freedom in response to movement of a control surface, and wherein the method further comprises moving the control surface to further adjust the position of the bending member. 
     
     
       3. The method of  claim 1 , wherein the device that extends caudally beyond the distal end of the shaft is configured to bend with only a single degree of freedom in response to movement of a control surface, and wherein the method further comprises moving the control surface to further adjust the position of the device that extends caudally beyond the distal end of the shaft. 
     
     
       4. The method of  claim 1 , wherein the device that extends caudally beyond the distal end of the shaft is configured to assume a pre-bent shape upon exiting the distal end of the shaft. 
     
     
       5. The method of  claim 1 , wherein the anterior-posterior axis is less than 2 cm away from the subject's clavicle bone, and the medial-lateral axis is less than 2 cm away from the subject's clavicle bone. 
     
     
       6. The method of  claim 1 , wherein the manipulating of the handle results in at least three of (i) rotating the shaft about the longitudinal axis of the shaft, (ii) rotating the shaft about the anterior-posterior axis with respect to the fulcrum, (iii) rotating the shaft about the medial-lateral axis with respect to the fulcrum, and (iv) advancing the shaft in the caudal direction. 
     
     
       7. The method of  claim 1 , wherein the device comprises a device for reducing a diameter of a tricuspid anulus. 
     
     
       8. The method of  claim 1 , wherein the device comprises a replacement for a tricuspid valve. 
     
     
       9. The method of  claim 1 , wherein the device comprises a clip for clipping leaflets of a tricuspid valve. 
     
     
       10. The method of  claim 1 , wherein the shaft has an outer diameter of less than 7.5 mm. 
     
     
       11. The method of  claim 1 , wherein the shaft has an outer diameter of 5.5-7.5 mm. 
     
     
       12. The method of  claim 1 , wherein the shaft has an inner diameter of at least 5 mm. 
     
     
       13. The method of  claim 1 , wherein the shaft has metal sidewalls with no openings in the sidewalls. 
     
     
       14. The method of  claim 1 , wherein the shaft has stainless steel sidewalls with no openings in the sidewalls. 
     
     
       15. A method of performing a procedure in a right side of a subject's heart, the method comprising:
 (a) introducing a distal end of a shaft into the subject's right internal jugular vein, wherein the shaft is hollow, straight, and stiff; 
 (b) advancing the distal end of the shaft into the subject's superior vena cava via the subject's right brachiocephalic vein until the distal end of the shaft is caudally beyond the subject's clavicle bone wherein at least a portion of the shaft remains outside the subject's body after the distal end of the shaft is caudally beyond the clavicle bone, and wherein the shaft passes directly posterior of the clavicle bone and adjacent tissue so that the clavicle bone and the adjacent tissue serve as a fulcrum; 
 (c) advancing a device in a caudal direction through an interior of the shaft so that the device extends caudally beyond the distal end of the shaft; and 
 (d) adjusting a position of the distal end of the shaft by manipulating a handle affixed to the portion of the shaft that remains outside the subject's body, 
 wherein the manipulating of the handle results in at least one of rotating the shaft about an anterior-posterior axis with respect to the fulcrum and rotating the shaft about a medial-lateral axis. 
 
     
     
       16. The method of  claim 15 , further comprising advancing the distal end of the shaft into the subject's right atrium after step (b) and prior to step (c), wherein at least a portion of the shaft remains outside the subject's body after the distal end of the shaft is advanced into the subject's right atrium. 
     
     
       17. The method of  claim 15 , wherein a bending member extends distally beyond the distal end of the shaft, wherein the bending member is configured to bend with only a single degree of freedom in response to movement of a control surface, and wherein the method further comprises moving the control surface to further adjust the position of the bending member. 
     
     
       18. The method of  claim 15 , wherein the device that extends caudally beyond the distal end of the shaft is configured to bend with only a single degree of freedom in response to movement of a control surface, and wherein the method further comprises moving the control surface to further adjust the position of the device that extends caudally beyond the distal end of the shaft. 
     
     
       19. The method of  claim 15 , wherein the manipulating of the handle results in at least three of (i) rotating the shaft about the longitudinal axis of the shaft, (ii) rotating the shaft about the anterior-posterior axis with respect to the fulcrum, (iii) rotating the shaft about the medial-lateral axis with respect to the fulcrum, and (iv) advancing the shaft in the caudal direction. 
     
     
       20. The method of  claim 19 , wherein the anterior-posterior axis is less than 2 cm away from the subject's clavicle bone, and the medial-lateral axis is less than 2 cm away from the subject's clavicle bone.